Recent press coverage of the challenges faced by the NHS this winter has resulted in widespread recognition that ‘something must be done’ – and, not least, amongst the thousands who rallied in support of it last weekend.
Whether people want to see improved access to primary care, shorter waiting times across Accident and Emergency departments or, as has become increasingly topical, action to reduce the length of waiting lists for elective surgery, people are increasingly supportive of calls for additional funds for frontline professionals, provider representatives and commissioners alike.
By contrast, the range of issues impacting the provision, quality and standards of adult social care services are widely misunderstood. There is a growing sense of unease amongst the general public about how we care for those most in need of assistance – in particular, our increasingly elderly population. I hear it whispered, more and more, on the lips of friends charged with navigating the system in seeking care for parents and loved ones. But, somehow, the unease has yet to result in an impetus for substantive action. Somehow, the sector struggles to make its voice heard and cause resonate sufficient to underpin an effective rallying cry.
The Government recently reclassified the Department of Health such that we now benefit from a Department of Health and Social Care and that is, perhaps, an acknowledgement that the proverbial sands might be about to shift. Like the Directors of Adult Social Services who regarded it as a “welcome recognition of the importance of social care”[i], we are hopeful that this signals a real shift in emphasis.
To date, however, the signs could be more encouraging.
All too often, when adult social care is referenced in policy documents and reports, it is over-shadowed by recommendations and plans for the funding and provision of health services.
In Facing the Facts, shaping the future: a draft health and care workforce strategy for England to 2027, a lengthy strategy document comprising eight chapters, only one is explicitly concerned with social care.[ii] The corresponding consultation questions include an isolated question about social care[iii] (and, small wonder, given Health Education England, who took the lead in developing the document, has no formal responsibility for the social care workforce).
Likewise, earlier this week, in the report of an expert panel convened by the Liberal Democrats, Health and social care: delivering a secure funding future [iv], adult social care was in some respects treated as a poor relation. Whilst the recommendation which hit the headlines was that of a ring-fenced tax for health and social care, which the authors argue should result in an overhauling of National Insurance, the report went on to call for an OBR-style body – but only to independently assess the funds needed to provide adequate health services now and in the future.
Where is the parity of esteem in that?
It’s not difficult to see why health dominates political debate at a time when the principles underpinning the NHS consistently receive strong public support[v], but the levels of dissatisfaction with adult social care services are much higher[vi] – so, surely, there is good reason for something to be done?
This week’s National Audit Office (NAO) report about the adult social care workforce helpfully recognises the lack of attention afforded to adult social care, and notes that that the Department of Health and Social Care is “not doing enough to support the development of a sustainable care workforce”[vii] – which would, in turn, impact the quality and standard of care people receive. It makes plain we need to take steps in the short, medium and longer term to ensure a sustainable social care workforce meets the needs of everyone in need of care – echoing our own calls for improved planning in relation to both health and care.
Specifically, its authors recommend a robust national workforce strategy for care be developed – in a similar vein to the draft strategy for the health sector. Other recommendations highlight the need to plan ahead for the workforce that will be required in an integrated health and care system and encourage local as well as national workforce planning.
But, do these recommendations go far enough? How might we take tangible action while (so many) strategies and plans are in the process of being developed and consulted upon by Government?
There is a pressing need to professionalise and empower workers in the adult social care sector, and to provide the right environment to attract and retain excellent staff. Vic Rayner, writing in the Guardian last month, said that steps need to be taken sooner rather than later – urging government to “bite the bullet around professionalising the sector” in the forthcoming green paper.[viii] One way to proceed apace could involve the establishment of a National Institute for Care, and flow from action taken by providers and their employees, rather than wait for the Government machine to process its own next steps.
Whatever happens next, we need to talk more about adult social care, and take practical next steps as soon as possible to meet the care needs of our growing and ageing population.